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General NPI Number Information
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NPI Number | 1730826991
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Entity Type | Individual
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Provider Name | VICTOR JOACHIM MEDINA PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 3107 W CAMP WISDOM RD STE 131
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City | DALLAS
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State | TX
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Zip | 75237-2600
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Country | US
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Telephone | 214-339-4533
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Fax |
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Provider Business Mailing Address
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Address Line | 10416 PRESTON VINEYARD DR
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City | FRISCO
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State | TX
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Zip | 75035-6163
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Country | US
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Telephone | 432-924-5703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1360974
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License Number State | TX
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